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Cabral S. Unlocking Transcatheter Aortic Valve Replacement Expertise in Brazil: Lessons from National Data. Arq Bras Cardiol 2024; 121:e20240302. [PMID: 39140560 PMCID: PMC11341207 DOI: 10.36660/abc.20240302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 08/15/2024] Open
Affiliation(s)
- Sofia Cabral
- Centro Hospitalar Universitário de Santo AntónioPortoPortugalCentro Hospitalar Universitário de Santo António, Porto - Portugal
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Miyoshi H, Kamiya S, Ikeda T, Narasaki S, Kondo T, Syourin D, Sumii A, Kido K, Otsuki S, Kato T, Nakamura R, Tsutsumi YM. Impact of proficiency in the transcatheter aortic valve implantation procedure on clinical outcomes: a single center retrospective study. BMC Anesthesiol 2024; 24:209. [PMID: 38907200 PMCID: PMC11191309 DOI: 10.1186/s12871-024-02594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 06/10/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND We used transcatheter aortic valve implantation (TAVI) procedure time to investigate the association between surgical team maturity and outcome. METHODS Among patients who underwent TAVI between October 2015 and November 2019, those who had Sapien™ implanted with the transfemoral artery approach were included in the analysis. We used TAVI procedure time and surgery number to draw a learning curve. Then, we divided the patients into two groups before and after the number of cases where the sigmoid curve reaches a plateau. We compared the two groups regarding the surveyed factors and investigated the correlation between the TAVI procedure time and survey factors. RESULTS Ninety-nine of 149 patients were analysed. The sigmoid curve had an inflection point in 23.2 cases and reached a plateau in 43.0 cases. Patients in the Late group had a shorter operating time, less contrast media, less radiation exposure, and less myocardial escape enzymes than the Early group. Surgical procedure time showed the strongest correlation with the surgical case number. CONCLUSION The number of cases required for surgeon proficiency for isolated Sapien™ valve implantation was 43. This number may serve as a guideline for switching the anesthesia management of TAVI from general to local anesthesia.
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Affiliation(s)
- Hirotsugu Miyoshi
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
| | - Satoshi Kamiya
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Tsuyoshi Ikeda
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Soshi Narasaki
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Takashi Kondo
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Daiki Syourin
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Ayako Sumii
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Kenshiro Kido
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Sachiko Otsuki
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Takahiro Kato
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Ryuji Nakamura
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Yasuo M Tsutsumi
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
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3
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Malvindi PG, Berretta P, Capestro F, Bifulco O, Alfonsi J, Cefarelli M, Pierri MD, Di Eusanio M. Results and insights after 413 TAVI procedures performed by cardiac surgeons on their own. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 36:ivad074. [PMID: 37166498 PMCID: PMC10243841 DOI: 10.1093/icvts/ivad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/17/2023] [Accepted: 05/10/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Current evidence on transcatheter aortic valve implantation (TAVI) has been generated exclusively by cardiology studies and no operative data from cardiac surgeons are available. Here, we describe the development of our TAVI programme and report the results of transfemoral (TF) TAVI done by cardiac surgeons on their own. METHODS This study included all the TAVI procedures on native valve performed at Cardiac Surgery Unit, Ospedali Riuniti di Ancona, during the period October 2018 to July 2022. Relevant prospectively collected preoperative, intraprocedural and postoperative data were retrieved from the Institutional database. RESULTS A total of 413 patients were included in the study. Mean patients' age was 82 years and among them 44% (180/413) were male. STS score was 3.1% (2.2-4.4). Eighty patients underwent transapical TAVI and 333 patients had a TF approach. We progressively moved from transapical TAVI towards TF procedures that are now routinely performed on conscious sedation and using a fully percutaneous approach. After TF TAVI, 30-day mortality rate was 1%, cerebral stroke occurred in 2% of the cases, permanent pacemaker implantation was necessary in 23% of the patients and in 6% of the cases there was a moderate/severe degree of aortic regurgitation. There was no association between operators performing TAVI and 30-day mortality. CONCLUSIONS The acquisition of catheter-based skills and an adequate training allowed cardiac surgeons to perform on their own awake and fully percutaneous TF TAVI with similar results when compared with major randomized clinical trials and registries' experiences.
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Affiliation(s)
- Pietro Giorgio Malvindi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Filippo Capestro
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Olimpia Bifulco
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Alfonsi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Mariano Cefarelli
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Michele Danilo Pierri
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
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Istrate M, Dregoesc MI, Bolboacă SD, Botiș C, Ștef A, Bindea DI, Oprea A, Trifan CA, Moț ȘDC, Molnar A, Iancu AC. The effect of the learning curve on paravalvular aortic regurgitation and mid-term mortality in transfemoral transcatheter aortic valve implantation. Echocardiography 2022; 39:204-214. [PMID: 35026044 DOI: 10.1111/echo.15289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/08/2021] [Accepted: 12/18/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Paravalvular aortic regurgitation is an important independent mortality predictor in transcatheter aortic valve implantation (TAVI). Our study evaluated the association between paravalvular aortic regurgitation and mid-term mortality in relation with the learning curve, in patients with severe aortic stenosis who underwent transfemoral TAVI in the first 3 years since the establishment of the program. METHODS Patients with severe aortic stenosis who underwent transfemoral TAVI between 2017 and 2020 were included in the analysis. Paravalvular aortic regurgitation was assessed by transthoracic echocardiography at 48 hours after the procedure. All-cause mortality was evaluated after 30 days and at mid-term follow-up. RESULTS Paravalvular aortic regurgitation ≥grade II was associated with mid-term all-cause mortality (OR 4.4; 95%CI 1.82-11.55; p < 0.001), their prevalence declining after the first 60 cases. Baseline characteristics did not significantly differ in the first 60 patients from the rest of the cohort. Male sex (p = 0.006), advanced age (p = 0.04), coronary artery disease (p = 0.003), or elevated STS Score (p = 0.02) influenced mid-term survival. When adjusting for the presence of these factors, only age (OR 1.1; 95%CI 1.0-1.2), paravalvular aortic regurgitation ≥grade II (OR 3.9; 95%CI 1.3-12.9), and the number of days spent in the intensive care unit (OR 1.4; 95%CI 1.1-1.8) were independent predictors of mid-term all-cause mortality. CONCLUSIONS In a group of patients with severe aortic stenosis who underwent transfemoral TAVI in the first 3 years since the establishment of the program, paravalvular aortic regurgitation ≥grade II was associated with mid-term mortality, both declining after the first 60 cases.
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Affiliation(s)
- Mihnea Istrate
- "Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania
| | - Mihaela I Dregoesc
- "Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania
| | - Sorana D Bolboacă
- "Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Medical Informatics and Biostatistics, Cluj-Napoca, Romania
| | - Cătălin Botiș
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania
| | - Adrian Ștef
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania
| | - Dan I Bindea
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania.,"Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Cardiovascular Surgery, Cluj-Napoca, Romania
| | - Alexandru Oprea
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania.,"Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Cardiovascular Surgery, Cluj-Napoca, Romania
| | - Cătălin A Trifan
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania.,"Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Cardiovascular Surgery, Cluj-Napoca, Romania
| | - Ștefan D C Moț
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania.,The Romanian Academy of Medical Sciences, Bucharest, Romania
| | - Adrian Molnar
- "Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania.,"Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Cardiovascular Surgery, Cluj-Napoca, Romania.,The Romanian Academy of Medical Sciences, Bucharest, Romania
| | - Adrian C Iancu
- "Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania.,"Niculae Stăncioiu" Heart Institute, Cluj-Napoca, Romania.,The Romanian Academy of Medical Sciences, Bucharest, Romania
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Lorenzoni V, Barbieri G, Saia F, Meucci F, Martinelli GL, Cerillo AG, Berti S, Candolfi P, Turchetti G. The cost-effectiveness of transcatheter aortic valve implantation: exploring the Italian National Health System perspective and different patient risk groups. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1349-1363. [PMID: 34019220 PMCID: PMC8558181 DOI: 10.1007/s10198-021-01314-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 04/28/2021] [Indexed: 05/09/2023]
Abstract
OBJECTIVES To assess the cost-effectiveness (CE) of transcatheter aortic valve implantation (TAVI) in Italy, considering patient groups with different surgical risk. METHODS A Markov model with a 1-month cycle length, comprising eight different health states, defined by the New York Heart Association functional classes (NYHA I-IV), with and without stroke plus death, was used to estimate the CE of TAVI for intermediate-, high-risk and inoperable patients considering surgical aortic valve replacement or medical treatment as comparators according to the patient group. The Italian National Health System perspective and 15-year time horizon were considered. In the base-case analysis, effectiveness data were retrieved from published efficacy data and total direct costs (euros) were estimated from national tariffs. A scenario analysis considering a micro-costing approach to estimate procedural costs was also considered. The incremental cost-effectiveness ratio (ICER) was expressed both in terms of costs per life years gained (LYG) and costs per quality adjusted life years (QALY). All outcomes and costs were discounted at 3% per annum. Univariate and probabilistic sensitivity analyses (PSA) were performed to assess robustness of results. RESULTS Over a 15-year time horizon, the higher acquisition costs for TAVI were partially offset in all risk groups because of its effectiveness and safety profile. ICERs were €8338/QALY, €11,209/QALY and €10,133/QALY, respectively, for intermediate-, high-risk and inoperable patients. ICER values were slightly higher in the scenario analysis. PSA suggested consistency of results. CONCLUSIONS TAVI would be considered cost-effective at frequently cited willingness-to-pay thresholds; further studies could clarify the CE of TAVI in real-life scenarios.
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Affiliation(s)
- V Lorenzoni
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - G Barbieri
- Edwards Lifesciences Italia S.p.A, Milan, Italy
| | - F Saia
- Cardio-Thoracic-Vascular Department, RCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - F Meucci
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - G L Martinelli
- Department of Cardiac Surgery, IRCCS MultiMedica Sesto San Giovanni, Milano, Italy
| | - A G Cerillo
- Division of Cardiac Surgery, Careggi University Hospital, Florence, Italy
| | - S Berti
- Fondazione C.N.R Regione Toscana G. Monasterio, Massa, Italy
| | - P Candolfi
- Edwards Lifesciences S.A., Nyon, Switzerland
| | - G Turchetti
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
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Callea G. The Pivotal Role of Hospitals in Enhancing Rational and Appropriate Use of Resources for Mature Technologies: The Case of Transcatheter Aortic Valve Implantation. Clin Ther 2021; 43:796-797. [PMID: 33865642 DOI: 10.1016/j.clinthera.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Giuditta Callea
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20136 Milan, Italy.
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Salih KEMA, El-Samani EFZ, Bilal JA, Hamid EK, Elfaki OA, Idris MEA, Elsiddig HA, Salim MM, Missawi H, Abass M, Elfakey W. Team-Based Learning and Lecture-Based Learning: Comparison of Sudanese Medical Students' Performance. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1513-1519. [PMID: 34992488 PMCID: PMC8713705 DOI: 10.2147/amep.s331296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/04/2021] [Indexed: 05/03/2023]
Abstract
AIM Students' performance in TBL compared to LBL needs to be evaluated. This study aimed to compare students' performance in team-based learning and traditional lectures. METHODS A total of 176 class 4 and 202 class 6 medical students from University of Bahri, Khartoum, Sudan, participated in the study during 2018. Experienced staff were selected to conduct the teaching and assessment of the two groups, using the standard team-based learning procedure (iRAT, gRAT and AppT) in the first topic and the lecture-based learning procedure in the second, within the same time limit for the two methods. RESULTS The two classes overall mean score has a significant 5.1 points difference (p<0.001; 95% CI: 3.5, 6.0). Separate analysis showed consistency of superiority of TBL to LBL in either gender. A remarkable difference was observed when we compared the two methods in class 6 separately from class 4. Class 6 mean score was high for both TBL and LBL (77.2 and 70.2, respectively), with a significant mean difference of 7.0 (p<0.001; 95% CI: 5.1, 8.9). In class 4, the score was lower for both methods (mean of 62.8 for TBL and 59.9 for LBL). The mean difference of 2.95 points was still significant (p<0.05; 95% CI: 0.46, 5.43). Separate multivariate linear regression for TBL and LBL showed no significant difference in performance of males and females in either method. Controlling for gender in TBL, class 4 had a mean of -14.26 points, (p<0.001; 95% CI: -12.54, -15.98) less than class 6. Similarly, in LBL, class 4 had a mean of -10.18 points (p<0.001, 95% CI: -7.02, -13.35), less than class 6. CONCLUSION Students' performance using team-based learning was superior to lecture-based learning, irrespective of students' gender, noticeable among senior students.
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Affiliation(s)
- Karim Eldin M A Salih
- Department of Pediatrics, Faculty of Medicine, University of Bahri, Khartoum, Sudan
- Department of Pediatrics, College of Medicine, University of Bisha, Bisha, Saudi Arabia
- Department of Medical Education, College of Medicine, University of Bisha, Bisha, Saudi Arabia
| | - El-Fatih Z El-Samani
- Department of Community Medicine, School of Medicine, Ahfad University for Women, Khartoum, Sudan
| | - Jalal Ali Bilal
- Department of Pediatrics, College of Medicine, Shaqra University, Shaqra, Saudi Arabia
| | - Emtinan K Hamid
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Omer Abdelgadir Elfaki
- Department of Internal Medicine and Medical Education Unit, Al-Rayan Medical Colleges, Medina Munawara, Saudi Arabia
| | - Muawia E A Idris
- Department of Pediatrics, Faculty of Medicine, University of Bahri, Khartoum, Sudan
| | - Hind A Elsiddig
- Department of Pathology, Faculty of Medicine, University of Bahri, Khartoum, Sudan
| | - Maha M Salim
- Department of Pathology, Faculty of Medicine, University of Bahri, Khartoum, Sudan
| | - Hashim Missawi
- Department of Pathology, Maternity and Children Hospital, Medina Munawara, Saudi Arabia
| | - Mohammed Abass
- Department of Pediatrics, College of Medicine, Arabian Gulf University, Manama, Bahrain
| | - Walyeldin Elfakey
- Department of Pediatrics, Faculty of Medicine, University of Bahri, Khartoum, Sudan
- Correspondence: Walyeldin Elfakey Department of Pediatrics, Faculty of Medicine, University of Bahri, Po Box: 1660, Khartoum, SudanTel +249912364272Fax +249 155 888 406 Email
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